Mitragyna speciosa (Kratom) poisoning: Findings from ten cases

Peřan, David; Stern, Michael P.; Černohorský, Petr; Sýkora, Roman; Popela, Stanislav; Duška, František

doi:10.1016/j.toxicon.2023.107054

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…Most of these deaths were believed to result from co-consumption with other drugs. Depending on the symptoms, kratom-related overdose has been managed with the μopioid receptor antagonist naloxone to reverse the opioid-like effects (either from kratom or coingested opioids), whereas the dual α and β adrenergic antagonist labetalol has been used to manage sympathetic overactivation (Peran et al, 2023). Kratom-related withdrawal symptoms have been managed with a combination of naloxone and the partial μ-opioid agonist buprenorphine (Suboxone®) (Weiss and Douglas, 2021).…”

Section: Humanmentioning

confidence: 99%

Translating Kratom-Drug Interactions: From Bedside to Bench and Back

Tanna

Cech²,

Oberlies

et al. 2023

Drug Metab Dispos

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Kratom is a botanical natural product belonging to the coffee family, with stimulant effects at low doses and opioid-like effects at higher doses. During the last two decades, kratom has been purported as a safer alternative to pharmaceutical and illicit drugs to self-manage pain and opioid withdrawal symptoms. Kratom alkaloids, typically mitragynine, have been detected in biologic samples from overdose deaths. These deaths are often observed in combination with other drugs and are suspected to result from polyintoxications. This review focuses on the potential for kratom to precipitate pharmacokinetic interactions with object drugs involved in these reported polyintoxications. The legal status, chemistry, pharmacology, and toxicology are also summarized. The aggregate in vitro and clinical data identified kratom and select kratom alkaloids as modulators of cytochrome P450 (P450) enzyme activity, notably as inhibitors of CYP2D6 and CYP3A, as well as P-glycoprotein–mediated efflux activity. These inhibitory effects could increase the systemic exposure to co-consumed object drugs, which may lead to adverse effects. Collectively, the evidence to date warrants further evaluation of potential kratom-drug interactions using an iterative approach involving additional mechanistic in vitro studies, well designed clinical studies, and physiologically based pharmacokinetic modeling and simulation. This critical information is needed to fill knowledge gaps regarding the safe and effective use of kratom, thereby addressing ongoing public health concerns. SIGNIFICANCE STATEMENT The botanical kratom is increasingly used to self-manage pain and opioid withdrawal symptoms due to having opioid-like effects. The legal status, chemistry, pharmacology, toxicology, and drug interaction potential of kratom are reviewed. Kratom-associated polyintoxications and in vitro-in vivo extrapolations suggest that kratom can precipitate pharmacokinetic drug interactions by inhibiting CYP2D6, CYP3A, and P-glycoprotein. An iterative approach that includes clinical studies and physiologically based pharmacokinetic modeling and simulation is recommended for further evaluation of potential unwanted kratom-drug interactions.

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Section: Humanmentioning

confidence: 99%

Translating Kratom-Drug Interactions: From Bedside to Bench and Back

Tanna

Cech²,

Oberlies

et al. 2023

Drug Metab Dispos

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“…Restlessness, tremors, and convulsions are typical symptoms of serious overdosing with kratom (52). Hypertension, tachycardia, bradycardia, cardiac arrest, cardiac arrythmia, mydriasis, and miosis are other symptoms revealed in various case reports (53)(54)(55)(56). As seen from the case reports, kratom can exert oppose effects depending on individual conditions, kratom dose, and period of kratom intake.…”

Section: Kratom As a Drugmentioning

confidence: 94%

Pharmacology and toxicology of kratom

POHANKA

2023

BLL

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The term kratom is commonly used for both Mitragyna speciosa and herbal products prepared mainly from leaves. Kratom is well known as a drug that can serve as a less toxic and less-addictive painrelieving substitute for opium, as well as a therapy for hypertension, cough, and diarrhea. Its major alkaloid, mitragynine, also deserves concern. However, most people use kratom as a psychological stimulant, which carries a risk of addiction associated with negative social and health impacts. This paper reviews basic facts about kratom and its potential use in pharmacology, pharmacokinetics, and pharmacokinetics of its major alkaloid mitragynine (Tab.

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“…Among the identified articles, there were 20 clinical case [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] and 7 case series reports [33][34][35][36][37][38][39] published between 2022 and 2023. A vast majority of articles in the case and case series reports category were from the United States (20 articles).…”

Section: Case and Case Series Reportsmentioning

confidence: 99%

Research and publication gaps on kratom and kratom products: a scoping review of current literature

Vicknasingam,

Karunakaran,

Chawarski

2024

Current Opinion in Psychiatry

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Purpose of review Kratom plant, products derived from the plant, and plant phytochemicals are of great interest among researchers, clinicians, and consumers. However, there is a paucity of rigorously collected scientific data on their risk/safety profile and public health impact. This scoping review discusses original research articles published between 2022 and 2023. It focuses on identifying publication gaps on topics related to epidemiology, public health, and risk/safety profiles comparing evidence collected by researchers from Southeast Asia and the West. Recent findings Our review of the Scopus database identified a total of 55 publications, including clinical case reports and case series reports, surveys, studies enrolling human participants, and publications based on large-scale national surveys or large-scale national or international health system database records. Summary Overall, there is dearth of reliable data on key epidemiological factors, including the prevalence rates, and on objective and reliable indices of the risk/safety profiles. Rigorous and systematic studies including improved epidemiological surveillance, human laboratory, and controlled clinical studies are urgently needed to advance our understanding of public health consequences of consuming kratom and kratom-derived products and to improve our understanding of their risk/safety profile and additional analytical studies to better inform development of needed regulatory oversight.

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Mitragyna speciosa (Kratom) poisoning: Findings from ten cases

Cited by 7 publications

References 22 publications

Translating Kratom-Drug Interactions: From Bedside to Bench and Back

Translating Kratom-Drug Interactions: From Bedside to Bench and Back

Pharmacology and toxicology of kratom

Research and publication gaps on kratom and kratom products: a scoping review of current literature

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